Colon cancer screening rates are still low:

Overall, 58 percent of men and 51 percent of women [aged 50 to 74 years -ed] in the study reported ever having undergone endoscopy, but only 35 percent reported being tested in the five years before 1997. Just 42 percent of men and 31 percent of women reported endoscopy for screening (rather than for disease diagnosis or follow-up).

It is recommended by most organizations that people at average risk should start screening for colon cancer start at age 50. Those with a first-degree relative who has had colon cancer or an adenomatous polyp should start at age 40.

There are several options that can be discussed:

1) fecal occult blood test (FOBT) every year, with a colonoscopy if positive;

2) flexible sigmoidoscopy every 5 years;

3) FOBT + flexible sigmoidoscopy, FOBT should be done first because a positive result is an indication for colonoscopy, obviating the need for sigmoidoscopy;

4) colonoscopy every 10 years;

5) double-contrast barium enema every 5 years.

The ultimate decision should be a shared one between patient and physician.